Quality of life, work productivity impairment and healthcare resources in inflammatory bowel diseases in Brazil

BACKGROUND Inflammatory bowel diseases(IBD)have been associated with a low quality of life(QoL)and a negative impact on work productivity compared to the general population.Information about disease control,patient-reported outcomes(PROs),treatment patterns and use of healthcare resources is relevant to optimizing IBD management.AIM To describe QoL and work productivity and activity impairment(WPAI),treatment patterns and use of healthcare resources among IBD patients in Brazil.METHODS A multicenter cross-sectional study included adult outpatients who were previously diagnosed with moderate to severe Crohn’s disease(CD)or ulcerative colitis(UC).At enrolment,active CD and UC were defined as having a Harvey Bradshaw Index≥8 or a CD Activity Index≥220 or calprotectin>200μg/g or previous colonoscopy results suggestive of inadequate control(per investigator criteria)and a 9-point partial Mayo score≥5,respectively.The PRO assessment included the QoL questionnaires SF-36 and EQ-5D-5L,the Inflammatory Bowel Disease Questionnaire(IBDQ),and the WPAI questionnaire.Information about healthcare resources and treatment during the previous 3 years was collected from medical records.Chi-square,Fisher’s exact and Student’s t-/Mann-Whitney U tests were used to compare PROs,treatment patterns and the use of healthcare resources by disease activity(α=0.05).RESULTS Of the 407 patients in this study(CD/UC:64.9%/35.1%,mean age 42.9/45.9 years,54.2%/56.6%female,38.3%/37.1%employed),44.7%/25.2%presented moderate-to-severe CD/UC activity,respectively,at baseline.Expressed in median values for CD/UC,respectively,the SF-36 physical component was 46.6/44.7 and the mental component was 45.2/44.2,the EQ-visual analog scale score was 80.0/70.0,and the IBDQ overall score was 164.0/165.0.Moderate to severe activity,female gender,being unemployed,a lower educational level and lower income were associated with lower QoL(P<0.05).Median work productivity impairment was 20%and 5%for CD and UC patients,respectively,and activity impairment was 30%,the latter being higher among patients with moderate to severe disease activity compared to patients with mild or no disease activity(75.0%vs 10.0%,P<0.001).For CD/UC patients,respectively,25.4%/2.8%had at least one surgery,38.3%/19.6%were hospitalized,and 70.7%/77.6%changed IBD treatment at least once during the last 3 years.The most common treatments at baseline were biologics(75.3%)and immunosuppressants(70.9%)for CD patients and 5-ASA compounds(77.5%)for UC patients.CONCLUSION Moderate to severe IBD activity,especially among CD patients,is associated with a substantial impact on QoL,work productivity impairment and an increased number of IBD surgeries and hospitalizations in Brazil.

Preoperative rectal tumor embolization as an adjunctive tool for bloodless abdominoperineal excision:A case report

BACKGROUND Abdominoperineal excision(APE)-related hemorrhage can be challenging due to difficult access to pelvic organs and the risk of massive blood loss.The objective of the present study was to demonstrate the use of preoperative embolization(PE)as a strategy for blood preservation in a patient with a large low rectal tumor with a high risk of bleeding,scheduled for APE.CASE SUMMARY A 56-year-old man presented to our institution with a one-year history of anal bleeding and rectal tenesmus.The patient was diagnosed with bulky adenocarcinoma limited to the rectum.As the patient refused any clinical treatment,surgery without previous neoadjuvant chemoradiation was indicated.The patient underwent a tumor embolization procedure,two days before surgery performed via the right common femoral artery.The tumor was successfully devascularized and no major bleeding was noted during APE.Postoperative recovery was uneventful and a one-year follow-up showed no signs of recurrence.CONCLUSION Therapeutic tumor embolization may play a role in bloodless surgeries and increase surgical and oncologic prognoses.We describe a patient with a bulky low rectal tumor who successfully underwent preoperative embolization and bloodless abdominoperineal resection.

Real-world disease activity and sociodemographic,clinical and treatment characteristics of moderate-to-severe inflammatory bowel disease in Brazil

BACKGROUND Understanding the treatment landscape of inflammatory bowel diseases(IBD)is essential for improving disease management and patient outcomes.Brazil is the largest Latin American country,and it presents socioeconomic and health care differences across its geographical regions.This country has the highest increase in IBD incidence and prevalence in Latin America,but information about the clinical and treatment characteristics of IBD is scarce.AIM To describe the sociodemographic,clinical,and treatment characteristics of IBD outpatients in Brazil overall and in the Southeast,South and Northeast/Midwest regions.METHODS Multicenter,cross-sectional study with a 3-year retrospective chart review component.Patients with moderate-to-severe Crohn’s disease(CD)or ulcerative colitis(UC)were consecutively enrolled between October 2016 and February 2017.Active CD at enrollment was defined as a Harvey Bradshaw Index≥8 or a CD Activity Index≥220 or a calprotectin level>200μg/g or an active result based on colonoscopy suggestive of inadequate control during the previous year;active UC was defined as a partial Mayo score≥5.Descriptive statistics were used to analyze all variables.RESULTS In a total of 407 included patients,CD was more frequent than UC,both overall(264 CD/143 UC patients)and by region(CD:UC ratios of 2.1 in the Southeast,1.6 in the South and 1.2 in the Northeast/Midwest).The majority of patients were female(54.2%of CD;56.6%of UC),and the mean ages were 45.9±13.8 years(CD)and 42.9±13.0 years(UC).The median disease duration was 10.0(range:0.5-45)years for both IBD types.At enrollment,44.7%[95%confidence interval(CI):38.7-50.7]of CD patients and 25.2%(95%CI:18.1-32.3)of UC patients presented with active disease.More than 95%of IBD patients were receiving treatment at enrollment;CD patients were commonly treated with biologics(71.6%)and immunosuppressors(67.4%),and UC patients were commonly treated with mesalazine[5-Aminosalicylic acid(5-ASA)]derivates(69.9%)and immunosuppressors(44.1%).More than 50%of the CD patients had ileocolonic disease,and 41.7%presented with stricturing disease.One-quarter of CD patients had undergone CD-related surgery in the past 3 years,and this proportion was lower in the Northeast/Midwest region(2.9%).CONCLUSION In Brazil,there are regional variations in IBD management.CD outweighs UC in both frequency and disease activity.However,one-quarter of UC patients have active disease,and most are receiving 5-ASA treatment.

Preservation of the superior rectal artery in laparoscopic colectomy for slow transit constipation: Is it really associated with better outcomes?

Few patients with slow-transit constipation refractory to conservative treatment can benefit with a subtotal colectomy with ileorectal anastomosis with the preservation of the superior rectal artery.In this letter to the editor some important issues were discussed.First,the study did not include a comparison group.Second,they did not present the functional results in the short or long term related to the bowel function of these patients after surgery.Finally,the authors showed that this surgical procedure was safe,and no cases of leakage were found.

Real-world treatment patterns and disease control over one year in patients with inflammatory bowel disease in Brazil

BACKGROUND Crohn’s disease(CD)and ulcerative colitis(UC)are inflammatory bowel diseases(IBDs)with a remission-relapsing presentation and symptomatic exacerbations that have detrimental impacts on patient quality of life and are associated with a high cost burden,especially in patients with moderate-to-severe disease.The Real-world Data of Moderate-to-Severe Inflammatory Bowel Disease in Brazil(RISE BR)study was a noninterventional study designed to evaluate disease control,treatment patterns,disease burden and health-related quality of life in patients with moderate-to-severe active IBD.We report findings from the prospective follow-up phase of the RISE BR study in patients with active UC or CD.AIM To describe the 12-mo disease evolution and treatment patterns among patients with active moderate-to-severe IBD in Brazil.METHODS This was a prospective,noninterventional study of adult patients with active Crohn’s disease(CD:Harvey-Bradshaw Index≥8,CD Activity Index≥220),inadequate CD control(i.e.,calprotectin>200μg/g or colonoscopy previous results),or active ulcerative colitis(UC:Partial Mayo score≥5).Enrollment occurred in 14 centers from October 2016 to February 2017.The proportion of active IBD patients after 9-12 mo of follow-up,Kaplan-Meier estimates of the time to mild or no activity and a summary of treatment initiation,discontinuation and dose changes were examined.RESULTS The study included 118 CD and 36 UC patients,with mean±SD ages of 43.3±12.6 and 44.9±16.5 years,respectively.The most frequent drug classes at index were biologics for CD(62.7%)and 5-aminosalicylate derivates for UC patients(91.7%).During follow-up,65.3%of CD and 86.1%of UC patients initiated a new treatment at least once.Discontinuations/dose changes occurred in 68.1%of CD patients[median 2.0(IQR:2-5)]and 94.3%of UC patients[median 4.0(IQR:3-7)].On average,CD and UC patients had 4.4±2.6 and 5.0±3.3 outpatient visits,respectively.The median time to first mild or no activity was 319(IQR:239-358)d for CD and 320(IQR:288-358)d for UC patients.At 9-12 mo,22.0%of CD and 20.0%of UC patients had active disease.CONCLUSION Although a marked proportion of active IBD patients achieved disease control within one year,the considerable time to achieve this outcome represents an unmet medical need of the current standard of care in a Brazilian real-world setting.